Oral cancer: our plan for action

Blog Author
David Cross

Blog Date
15/11/2018

Page Content

Peter Young turned 70 this week. And he's clear that he would never have reached that milestone without his dentist.

In 2015 he attended a routine check-up in his hometown of Blanefield, near Stirling. His dentist spotted something underneath his tongue, and referred him to hospital the very next day. Tests confirmed it was oral cancer.

Six weeks on he underwent an eleven-hour operation. Three surgeons replaced tissue on his tongue with flesh from his arm. Another six-hour procedure followed.

His prospects hinged on a highly skilled team bringing skills from oral surgery to speech therapy – but none of that would have mattered had his cancer not been detected early.

In 2016 1,240 people in Scotland were diagnosed with oral cancers – nearly five cases every working day.

And while other cancers have seen marked improvements we have witnessed a 37 per cent increase in oral cancer deaths in the last decade.

So this year we set out to ask our members for feedback to shape a plan of action to tackle this devastating – but preventable disease – based on 3 key principles:

1. Early Detection

Cases like Peter's are a stark reminder of the value of early detection, which can almost double a patient's chances of survival. And we've warned the Scottish Government not to make early detection a casualty in a cost-cutting exercise that could mean the end of annual appointments for supposedly 'low risk' patients.

The Oral Health Improvement Plan contains provisions for recall intervals of up to 24 months.

We've gathered the evidence – and 97 per cent of Scottish dentists say they have concerns that could undermine detection of oral cancers – with 77 per cent defining it as a major or severe risk.

We need effective targeting of those who don't engage regularly with oral health services. But we know people in otherwise good health are succumbing to this disease.

We've been clear to Scottish Government and the media that telling our 'lower risk' patients to come back in two years will put lives at risk.

2. Prevention

Prevention is, as we all know, better than cure.

We've celebrated the Scottish Government's early commitment to extend the HPV vaccination programme to school-aged boys, but it's crucial they introduce it without delay, and offer a catch-up programme to 140,000 boys still in education.

There are also cuts to smoking and alcohol-cessation services that need to be reversed.

3. Joined-up services

Peter was delighted with the quality of care he received.

Oral cancer patients require interventions from over dozen highly-skilled specialists. But we know there are inconsistencies, in both referral and treatment, and we need to see commitments to ensure patients face a seamless journey, no matter what their postcode.

And we need Health Boards to build effective links between dentists, GPs and pharmacists.

We launched our plan on 13 November at the Scottish Parliament, on the eve on Peter's birthday, and were delighted to be joined by cancer survivors from across Scotland and MSPs from across the political spectrum.

Oral cancers come at a huge personal price to patients like Peter and their families, and can cost NHS Scotland up to £90,000 per case.

The total bill of nearly £65 million a year is set to more than double by 2035 if this disease goes unchecked.

We are often the first health professionals to spot the tell-tale signs – and our plan of action taps into the insights of those on the front line in the battle against this life changing condition.